Introduction

The Tool Kit is an integral part of Biosecurity in Practice. It contains many of the "how to's" and resource material practices will use in planning, implementing and delivery of training related to biosecurity. Many of the documents included in the tool kit section has been adapted from a wide variety of resources and referenced where references existed. It is assumed practitioners will adopt these materials to design biosecurity tools for use in their own practices and for clients.

Forward

Everyone is in favour of progress. It’s change they don’t like.

And so it is with biosecurity. Many clinics and institutions have been compelled into designing biosecurity programs as a result of disease outbreaks. Salmonellosis, expressed as a serious zoonotic threat involving animals, veterinary hospital staff and public has been widely documented as an initiating cause of enhanced biosecurity programs within individual veterinary practice entities (VPE).

Biosecurity are measures put in place to reduce the likelihood of the introduction of a disease into a country, region, or specific location, such as veterinary premises, or animal facility. Appropriate biosecurity measures will reduce transmission of disease within and between locations once a disease is already present. Biosecurity measures are often not specific to a particular disease or infectious agent, but rather a collection of important management or good production practices that reduce the risk of  infectious agents. Specific biosecurity measures for individual pathogens or facilities may be applied as needed. For example, the American Association of Swine Practitioners have developed protocols specifically designed to limit the introduction and transmission of PRRS. Likewise the dairy industry has introduced biosecurity practices to control Johne’s disease.

Animal diseases are transmitted in various ways, including direct and indirect contact in a horizontal fashion ( between animals of the same generation) or vertically (between dam and offspring before or during birth).

Direct contact is of particular significance for fragile pathogens unable to survive for extended periods outside the host; examples include feline lukemia virus (FeLV), feline immunodeficiency virus (FIV), or bovine virus diarrhea virus (BVD). Indirect contact between animals occurs via contaminated bedding, grooming kits, bowls, litter trays, medical equipment, boots and trucks used to transport livestock. Vectors can biological like midges responsible for transmitting many viral diseases in sheep and cattle, mosquitoes that transmit West Nile virus, western equine encephalitis and heartworm, or ticks responsible for transmitting diseases like Lyme disease and anaplasmosis. Biological vectors like the large biting flies (Tabanids) have been incriminated in mechanically transmitting anaplasmosis and anthrax. Feline diseases transmitted by biological vectors include feline infectious anemia (FIA), caused by Mycoplasma haemofelis, which is transmitted by fleas. People may also act as vectors by transporting infection on their skin, clothing or shoes. Examples include canine parvovirus (CPV), a virus which is highly persistent outside the host.

Biosecurity planning must be outcome oriented and provide answers to the question, “What will look different?” Five important outcomes include:

1. Concepts of public health are promoted among hospital personnel and clients
2. Risks of zoonotic disease are reduced
3. Patient care is optimized by minimizing the threat of nosocomial (hospital acquired) infections
4. Lifelong skills in public health and biosecurity are developed and promoted among hospital personnel
5. The veterinary  practice entity is protected from financial loss and litigation related to breaches in biosecurity

One approach to formulating a biosecurity plan is to incorporate Hazard Analysis and Critical Control Point (HACCP) concepts, a process originally developed to manage potential hazards to food safety. Using HACCP, biosecurity planning becomes proactive and preventative by identifying hazards before they threaten personnel, patients, or the normal clinic operations. HACCP is also a tool used for design of biosecurity programs for agriculture enterprises.

The HACCP approach has seven integrated steps:

1. Operational hazards are identified, analyzed and preventive measures described.
2. Critical control points (CCP) are noted. A CCP is a step where control can be applied and a hazard can be prevented, eliminated, or reduced to acceptable levels.
3. Critical limits associated with each CCP that would trigger enactment of preventive or corrective measures are established.
4. Monitoring processes are described and procedures established for using monitoring results to adjust and maintain control of operations.
5. Corrective actions to be taken when critical limits are exceeded are described
6. Verification procedures that HACCP is working properly are determined
7. Effective record-keeping procedures documenting the HACCP system are developed.

The hospital is divided into service areas that were considered separately when designing biosecurity protocols. For example: small animal, food animal, equine, exotic/zoo animal, and ancillary services (e.g. radiology, clinical pathology, and isolation wards). A biosecurity plan has sections devoted to issues relating to operations overall and to each specific service area. While HACCP plans for food safety address biological, chemical, and physical hazards, the clinic biosecurity plan addresses biological hazards.

Hazard Analysis:

Contagious infectious diseases are the major biological hazard to patients and staff. Nosocomial transmission of pathogens important to biosecurity at are fecal-oral for gastrointestinal pathogens and aerosol for respiratory pathogens. Another important concern is contamination and infection of surgical wounds. In addition, specific zoonotic agents are given special consideration because of their potential for morbidity and mortality in people. Agents of regulatory concern are also given special priority because of the risk to normal hospital operations and the regulatory necessity to report. Infectious organisms recognized as common and/or important threats to biosecurity need to be identified e.g. Salmonella, Cryptosporidium parvum, equine influenza virus, canine parvovirus, organisms associated with neonatal scours, feline immunodeficiency virus,Streptococcus equi, Yersinia pestis, and ectoparasites.

Critical Control Points and Corrective Actions:

Transmission of infectious agents via contact is one of the greatest biosecurity concerns for the VPE. General, foundation principles for controlling contagious diseases are emphasized throughout the hospital. Actions concerning these principles that are employed throughout the hospital include frequent hand washing, appropriate cleaning and disinfection of contact surfaces, using appropriate attire by hospital personnel, the use of barrier nursing procedures, and providing break areas for personnel away from animal housing and handling areas where food can be stored and consumed with less risk of exposure to zoonotic agents.

Hand washing is considered by the Centers for Disease Control and Prevention as the most important step in preventing the transmission of infectious diseases. Instructions are provided to personnel regarding correct hand washing technique, and all personnel must wash their hands before and after handling any animals in the hospital.

In the event that an area becomes contaminated with potentially infectious material, guidelines should describe appropriate methods for disinfecting contaminated areas. Protocols are included for disinfecting surfaces and hospital equipment that is exposed to animals or animal material.

All hospital personnel should be required to wear clean protective attire whenever working in the hospital. The standard attire is intended to provide a minimum level protection from infectious agents, it can be easily changed if it becomes soiled or contaminated, and also serves to heighten awareness to potential biosecurity hazards. Smocks or laboratory coats are required in the small animal areas, and smocks or coveralls are required in the large animal areas. All personnel must wear closed-toe footwear that is easily cleanable and rubber overboots are standard attire the in-patient areas of the large animal hospital.

Barrier nursing precautions are another effective step in preventing the transmission of infectious agents whenever it is desirable to take extra precautions. Barriers are used in isolation areas and for patients with special needs, e.g. foals and patients with compromised immune systems. Barriers include disposable plastic gowns, gloves, plastic or rubber overboots, and footbaths for each patient.

In addition to general biosecurity practices, the service areas have specific control points and corrective actions, and are further divided according to differences in the perceived shedding of infectious agents. For example, outpatients are generally considered to have the lowest risk of shedding important infectious agents, while hospitalized patients with the highest risk of shedding important infectious agents are housed in isolation facilities. Additional monitoring and biosecurity precautions are employed as the risk of shedding infectious agents increases.

Pathogen Monitoring:

A program should be created to monitor the biosecurity procedures and provide feedback to a biosecurity committee, or at least someone designated as overseer. Some clinics may choose to maintain an active surveillance system in which environmental and patient samples are collected for routine bacterial isolation and identification. Samples could be routinely collected from large animal patients, equine patients, and other animals that are considered to be at high risk for shedding pathogenic bacteria. In addition, the program collects and maintains records of bacterial isolates and any identified nosocomial spread of disease. Corrective measures are based on analysis of the data collected.

References

1. Colorado State University Veterinary Teaching Hospital. Biosecurity Standard Operating Procedures.
2. United States Department of Agriculture, Food Safety Inspection Service. Pathogen Reduction/HACCP & HACCP Implementation.
3. Bolyard EA, Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchman SD. Guideline for infection control in health care personnel, 1998. American Journal of Infection Control 1998:26:289-354
4. Proceedings of the 9th International Symposium on Veterinary Epidemiology and Economics, 2000 Available at www.sciquest.org.nz

The Biosecurity web-based Tool Kit hold a number of key reference documents that will provide both as a general overview and detailed  examination of what a biosecurity plan should contain depending on the type and scope of veterinary practice.